UNDER AGE 65 HEALTH PLANS FOR PARTICIPANTS. Kern County 2018 Retiree

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1 Kern County 2018 Retiree HEALTH PLANS FOR PARTICIPANTS UNDER AGE 65 For current participating physician information, please contact each plan directly. This summary is for information purposes only. Members should review complete plan document before enrolling. If any item differs between these summaries and any plan documents, the plan document will govern.

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3 Kern Legacy Health Plan Network Plus Kern Legacy Health plan added a Preferred Provider Organization (PPO) tier to the existing Exclusive Provider Organization (EPO) benefit. Members will still be able to access services at the EPO level for little to no cost but can also access the new PPO-level benefit with an expanded listing of PPO providers for 20% coinsurance after deductible ($250/individual and $500/family). Kern Legacy will still be centered on services provided by Kern Medical Center for hospital, prescription, and specialist physician care at the EPO level benefit. $0 Deductible Premier EPO Level $10 co-pay for Primary Care Physician office visit co-payment $20 co-pay for specialist co-payment with referral $15 co-pay for Urgent Care $0/day Hospitalization co-payment at Kern Medical Center Outpatient Surgery: $0 co-pay at KMC; $50 co-pay at Surgery Center $25 co-pay for CT/PET/MRI Additional PPO Level Deductible of $250 single / $500 family No PCPs at PPO level No wellness visits at PPO level 20% Coinsurance for PPO Specialist, initial consult is self-refer 20% Coinsurance for PPO contracted inpatient or out-patient hospital or surgery center 20% Coinsurance for PPO contracted lab or radiology services Chiropractic EPO is $10 per visit; PPO is 20% coinsurance after deductible (maximum 20 visits per calendar year) $150 emergency room co-payment applies unless admitted. Out of Area Emergency Services must be approved by plan administrator (must call plan administrator within 48 hours or the next business day. $100/day co-pay applies to any approved non-network admission. Prescription Benefit KMC (Retail and Mail Order, up to 90 day supply) - $0 generic; $20 preferred brand; $40 nonpreferred. Non-KMC Retail (up to 30 day supply) - $5 generic; $45 preferred brand; $65 non-preferred If a retiree participant or dependent is eligible for Medicare, then Medicare is primary and the Kern Legacy Health Plan Network Plus is secondary. For additional plan information, please visit our website at For Kern Legacy Health Plan Network Plus enrollment forms, contact Kern County Human Resources-Health Benefits at (661)

4 Kaiser Permanente Group # $15 co-payment for medical office visit $10 Generic / $20 Name Brand co-payment for prescriptions from plan pharmacy, up to a 100 day supply $15 co-payment per procedure for Outpatient surgery No charge for most X-Rays and laboratory tests. Durable Medical Equipment: 20% per item No co-payment for hospital services. $50 co-payment for in-area emergency services and specified coverage for out-of-area emergency services, waived if admitted. Worldwide coverage. No co-payment for authorized in area skilled nursing facility care, up to 100 days per calendar year. Home Health care, up to hour visits per calendar year, with no co-payment. Frame allowance of $125 on eye wear purchased from Kaiser contracted facilities every 24 months. For additional plan information, please contact: Jose Hernandez at Kaiser Permanente at (661) For Kaiser Permanente enrollment forms, contact Kern County Human Resources Health Benefits at (661)

5 Health Net Under 65" HMO Group # 50874T $5 co-payment for office visit (at participating provider group) No charge for x-ray and laboratory procedures No charge for durable medical equipment No charge for hospital stays (semi-private or intensive care) $35 co-payment for emergency room and $35 for urgent care facility, waived if admitted. $5 co-payment for vision and hearing exams $100 frame allowance (once every 24 months) $5 co-payment for chiropractic care (20 visits per calendar year) Prescriptions: Retail: $5 generic $10 brand prescription co-payment (plan formulary), $35 co-pay for non-formulary drugs, up to a 30-day supply Mail order (90 day supply): $10 generic $20 brand prescription co-payment (plan formulary) $70 co-pay for non-formulary drugs Local (Kern County) providers: GEMCare Medical Group Bakersfield Family Medical Center/Heritage Physicians Network Independence Medical Group. For additional plan information, please call Health Net at (800) For Health Net Under 65 enrollment forms, contact Kern County Human Resources Health Benefits at (661)

6 County of Kern EPO Plan (Administered by Managed Care Systems) The County of Kern EPO (Exclusive Provider Organization) plan and prescription coverage is one of the plans that is available to active County employees, and is administered by Managed Cared Systems (MCS) which includes: $10 Primary Care Physician office visit co-payment $15 specialist co-payment with referral $100/day Hospitalization (maximum $500/year per member) co-payment $75 Emergency Room Services co-payment (waived, if admitted) World-wide emergency care as approved by plan administrator Calendar Year Out-of-Pocket Maximum: $1000 per member; $3000 per family Prescription Drugs through NPS (retail) or IHMO (mail order): Generic Preferred Brand Name Non-Preferred Brand Name $ 5.00 (30 day retail) or $10.00 (90 day mail order) $10.00 (30 day retail) or $20.00 (90 day mail order) $25.00 (30 day retail) or $50.00 (90 day mail order) $10 per visit for chiropractic care benefit (maximum 20 visits per calendar year) Under the EPO plan you may utilize primary care physicians that are contracted with GEMCare or Delano Medical Center (DMG). There is no coverage for providers who are not in one of these medical groups for non-emergency services. If a retiree participant or dependent is eligible for Medicare, then Medicare is primary and the County of Kern EPO plan is secondary. For additional plan information, please visit our website at For County Of Kern EPO enrollment forms, contact Kern County Human Resources Health Benefits at (661)

7 County of Kern POS Plan The County of Kern POS (Point of Service) Plan offers you the same medical and prescription coverage that is available to active County employees, which includes In-Network benefits: $15 Primary Care Physician office visit co-payment $25 specialist co-payment with referral $150/day Hospitalization (maximum $750/year per member) co-payment World-wide emergency care as approved by plan administrator (must call plan administrator within 48 hours or the next business day) $75 emergency room co-payment applies unless admitted Prescription medications through WellDyneRx (retail and mail order) or Specialty medications through US Specialty Care: Generic Preferred Brand Name Non-Preferred Brand Name (if no generic available) Non-Preferred Brand Name (if generic is available) $5.00 (30 day retail) or $10.00 (90 day mail order) or $0 at KMC pharmacies $25.00 (30 day retail) or $50.00 (90 day mail order) $40.00 (30 day retail) or $80.00 (90 day mail order) Non-preferred co-payment plus the difference in retail cost between the brand name and the generic drug $20 reimbursement chiropractic care benefit (30 annual visits maximum) Option to choose non-preferred provider services with reduced benefits (70% coverage of Usual & Customary charges after $200 deductible for covered services) If a retiree participant or dependent is eligible for Medicare, then Medicare is primary and the County of Kern POS plan is secondary. For additional plan information, please visit our website at For County Of Kern POS enrollment forms, contact Kern County Human Resources Health Benefits at (661)

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